UNIVERS

IDAD ANAHUAC

Maestría en Psicopedagogía

Reporte de entrevista familiar

Nombre del paciente identificado: ________________________________________

Fecha de nacimiento: _______________________ Grado escolar: _______________________

Motivo de consulta:
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Nombre de la familia: ___________________________________________________________________

Nombre de la terapeuta: ________________________________________________________________

Geografía de la sesión:

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Familiograma:

Mapa familiar:

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Diagnóstico estructural:

Jerarquía______________________________________________________________________________
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Límites
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Alianzas
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Coaliciones
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Hipótesis sistémica:
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Diagnóstico dinámico.

Problemas:____________________________________________________________________________
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Comunicación:
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Expresión de afecto:
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Involucramiento afectivo:
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Roles:
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Control conductual:
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Funcionamiento general de la familia (re-encuadre):

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Objetivos terapéuticos a trabajar:

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